| NPI | 1215038054 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: NC 200501030) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: NC 01030) |
| 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: NC 01030) | |
| Enumeration Date | 2006-09-26 |
| Last Update Date | 2020-10-25 |